Is alcohol intoxication or otitis media (inflammation of the middle ear) a more common cause of repetitive horizontal movement of the eyes, also known as nystagmus?

From the Guidelines

Alcohol intoxication is a more common cause of nystagmus (repetitive horizontal eye movement) than otitis media. While both conditions can cause nystagmus, alcohol-induced nystagmus occurs frequently in intoxicated individuals due to alcohol's direct effect on the vestibular system and cerebellum, which control eye movements and balance. This typically presents as horizontal gaze nystagmus, where the eyes jerk involuntarily when looking to the side. In contrast, nystagmus from otitis media is less common and typically occurs only when the infection spreads beyond the middle ear to affect the inner ear (labyrinthitis) or vestibular nerve, as discussed in the context of otitis media complications 1. Alcohol-induced nystagmus is temporary and resolves as the body metabolizes the alcohol, while otitis media-related nystagmus requires treatment of the underlying infection, usually with antibiotics. The presence of nystagmus in someone with ear pain should prompt evaluation for possible complications of otitis media affecting the inner ear or central nervous system, considering the potential for benign paroxysmal positional vertigo (BPPV) as a related condition 1.

Some key points to consider:

• Otitis media is a spectrum of diseases, including acute otitis media (AOM), otitis media with effusion (OME), and chronic suppurative otitis media (CSOM) 1.
• BPPV is a disorder of the inner ear characterized by repeated episodes of positional vertigo, with posterior canal BPPV being more common than horizontal canal BPPV 1.
• The supine roll test is used to diagnose lateral canal BPPV, which can present with geotropic or apogeotropic nystagmus 1.
• The management of otitis media and its complications, including the use of antibiotics and the consideration of BPPV, is crucial for preventing long-term sequelae and improving quality of life. Given the complexity of these conditions and their potential impact on morbidity, mortality, and quality of life, it is essential to approach each case with a thorough evaluation and evidence-based management strategy.

From the Research

Comparison of Causes of Repetitive Horizontal Movement of the Eyes

• Repetitive horizontal movement of the eyes, also known as nystagmus, can be caused by various factors, including ear problems and alcohol intoxication.
• Otitis media, or inflammation of the middle ear, has been linked to vestibular symptoms, including nystagmus, in several studies 2, 3, 4.
• A study published in 2016 found that patients with serous labyrinthitis caused by acute otitis media exhibited various patterns of nystagmus, with direction-fixed irritative-type nystagmus being the most common pattern 2.
• Another study published in 2018 found that patients with otitis media have increased chances of having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests compared to controls 3.
• In contrast, alcohol intoxication is also a well-known cause of nystagmus, as it can affect the vestibular system and cause imbalance and coordination problems 5.
• However, the available evidence suggests that otitis media may be a more common cause of repetitive horizontal movement of the eyes, particularly in patients with a history of ear problems or vestibular symptoms 2, 3, 4.

Vestibular Symptoms and Otitis Media

• Several studies have investigated the association between otitis media and vestibular symptoms, including nystagmus, and found a significant link between the two 2, 3, 4.
• A study published in 2024 found that children with a history of recurrent acute otitis media demonstrated significantly greater postural instability and vestibular dysfunction compared to healthy controls 4.
• The evidence suggests that otitis media can lead to lasting balance and vestibular dysfunction, highlighting the importance of early monitoring and potential rehabilitation 4.

Alcohol Intoxication and Nystagmus

• Alcohol intoxication is a well-known cause of nystagmus, as it can affect the vestibular system and cause imbalance and coordination problems 5.
• However, the available evidence does not suggest that alcohol intoxication is a more common cause of repetitive horizontal movement of the eyes compared to otitis media 2, 3, 4.